| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,794 |
5,183 |
$1.18M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,301 |
3,201 |
$661K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,831 |
2,167 |
$466K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,484 |
1,816 |
$397K |
| D1110 |
Prophylaxis - adult |
7,062 |
7,034 |
$306K |
| D0140 |
Limited oral evaluation - problem focused |
6,042 |
5,965 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
7,930 |
7,906 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,631 |
4,611 |
$179K |
| D0210 |
Intraoral - complete series of radiographic images |
2,153 |
2,133 |
$164K |
| D0274 |
Bitewings - four radiographic images |
5,378 |
5,361 |
$158K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
222 |
187 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
7,930 |
7,771 |
$97K |
| D2950 |
|
659 |
590 |
$81K |
| D2740 |
Crown - porcelain/ceramic |
76 |
46 |
$64K |
| D4342 |
|
320 |
135 |
$28K |
| D2330 |
|
231 |
144 |
$23K |
| D2394 |
|
76 |
62 |
$14K |
| D2331 |
|
114 |
81 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
252 |
249 |
$7K |
| D4346 |
|
129 |
129 |
$6K |
| D2332 |
|
21 |
15 |
$3K |
| D4341 |
|
29 |
13 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
14 |
$3K |
| D2335 |
|
13 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
71 |
69 |
$2K |
| D0460 |
|
16 |
14 |
$414.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$359.71 |